To wonder why it takes a GP 7 years to train?

[Swedes2Turnips1]

When all they seem to do is say 'I will write you a letter of referral' or 'You will have to make an appointment with the practice nurse for that'. What do they actually do these days?

(Not that I am saying there is anything wrong with that - that's the way it works, we delegate what we can, they refer what they need to.)

i don't mind a nurse doing smears.

i mean, it's not exactly fanjoplasty.

Will Northerner have been speculumised after her smear?

Or just smeared?!

(Snork)

I did say 'ow' then 'OW' - then she said 'now it shouldn't hurt' and I swear the words 'you've got to get through labour you know' were on the tip of her tongue when she said 'oh sorry.....' - thing is - after that the actual swab was a picnic!

I will describe myself as having been 'smeared' I think - specularised sounds so clinical

i'd rather be smeared than spec'd because i'm sorry, i've had more than my share of procedures and those damn specs are just uncomfortable no matter what.

glad i was out cold for the last one.

how do you feel today expat - physical recovery going ok?
It's supposed to be better if they warm the specthingys - can't see it makes much difference myself - it's still a HUGE metal thing somewhere you don't want one!

I thought I was going to be 100% today, Northern.

Guess I was wrong .

I still have some cramps, but very little bleeding, thankfully - tough wood.

Of course, I probably don't help matters by getting on my feet asap.

I hate laying around, being a burden or relying on others and am so impatient I'd rather just get up and do things myself.

I was taken back up to my room from recovery, and immediately got up and got out: my portable kettle, tea and UHT milks for a cuppa, my personal supply of co-cocodamol and my snacks. After changing into my own PJ's and putting on my dressing gown and slippers, I put on some clean knickers and my own sanitary protection, then filled my hot water bottle.

By the time the nurse came in, I had my cuppa and was putting my make up on.

No shit!

She couldn't believe it.

Thankfully, I brought my own sleeping tablets, too.

I tried to get them to let me go home, but they said they'd give me stuff to help me sleep.

I told them it would have nothing on Ambien CR.

I was right.

At 2AM, after the 10 mils of diazepam did abolutely nothing, I popped my own for some shut eye.

I never travel unprepared, me .

expat - you sound like a prime example of someone who does best when doing things your own way

Hope you are 100% tomorrow

i'm a prime example of a PITA .

i think i'll be better tomorrow.

about to go to bed here because i am still a bit sore.

I don't think GP's are a waste of space - well not all of them anyway but I do hate loathe and detest my local surgery.

1. It is run down and horrible to be there
2. There are no toys or books for children
3. You can't go to the loo because they keep it locked up (!!!). Try going there with cystitis - unbelievable.
4. So you queue up to ask for the keys for the loo, and they explain that they keep it locked up because of all the addicts shooting up in there (!!!!) and you return to your seat and see three blood soaked (so by now you are worrying about HIV infection from the druggies) swabs littering the floor of the surgery which the tots could have picked up and played with...
5. There are shedloads of curling, unpleasant and admonitory notices about how many missed appointments there have been - absolutely no acknowledgement of the fact that you have to wait for over a week for an appointment and then have to queue for up to an hour ...
6. The staff have a siege mentality and are totally lazy and unhelpful. An example of this is when I asked for the results of a blood test that they SAID would have come in 3 days previously - you are anxious because you have a child in pain - so you ask them politely if they think they could chase it up - whilst inwardly seething that they have spent the last 24 minutes standing around chatting and having a teaparty - visibly and unashamedly doing NO EFFING WORK AT ALL - and they look at you like you have literally lost your mind because you've asked them to make a phone call ....

And I am paying through the nose for this ...

GRRRRRRRR

Rant over.

How many of you though think you could have done (along the lines of what itscold did today), what my dh did.

He also had to tell one woman in her 40s that her breast cancer is back and agressive, and another family that their mother is dying.

He does this because he has extnsive training in communicating bad news. He can also do all the normal GP stuff, has a special interest in psychiatry so can do a lot of care which is otherwise done in hospitals, especially psychogeriatrics, dealing with depressed and confused older people, can run a "home hospice" service to allow people to die at home, whcih is what most people want, but most people dont get, and can deal with any trauma that comes in - today, a rear ending that put a car down a long drop and he was able to assess and deal with all casualties before the ambulance came.

It upsets me when GPs are given a bad name in general as I know how hard they all work - he was home early tonight at 6.45, had officially "finished" work at 1pm! Even given the 75 min commute, thats a long half day. And we know a lot of GPs (obviously) - they all work this hard.

I had a chronic kidney condition for 3 years, and my GP was able tokeep me out of hospital with daily appointments to assess my pain and kidney function. This was totally above and beyond, and I am eternally grateful to the practice who did it.

I think a lot of people are criticising GPs for the trivial things. Those of us who have had to use the service intensively for chronic trouble are, in the main, very impressed.

Or maybe I'm biased.

There are some real questions to be addressed though, aren't there? I am not sure that iterating all the highly useful things that GPs do, or can do, actually gets us close to those.

There are not enough doctors in the UK.

There are not enough doctors because we don't train enough.

We don't train enough partly because we as a society don't want to, but also partly I think the medical profession has colluded in this.

Because if you restrict supply (of doctors) in a society where demand is high then you increase the salaries that they are paid.

So just how highly skilled does a GP's job need to be? That's a different question from how highly skilled GP's are. I don't know the answer to that question, by the way.

Also, I know we are used to it and all that, but why should access to healthcare have gatekeepers?

And why should those gatekeepers be GPs?

Quattro - Very good points.
It is probably true that if you are very seriously ill you really do not care about the inconvenience of an 11.30am appointment. You probably also have the opportunity to strike up some sort of rapport with your GP and the surgery staff. It seems that people with very serious or long term condition get excellent care but the casual user find the whole experience rather user-unfriendly. Of course it is better that it is that way round but it would be nice if room for improvement was acknowledged. I am finding all this patting one another on the back a bit weird.

Erm - hate to disagree Quattro but we are training more and more doctors. I am trying to get back to work after maternity leave. Five years ago I was the only applicant to the job I applied for. This week I have applied for 3 jobs and all of them have had over 60 applicants. This is for GP work.

Because of the new training the powers that be have introduced we do have a lot of unemployed doctors and lots of UK trained doctors are moving to places like Australia to work.

As a locum I have worked in many many GP surgeries. All have slightly different appointment systems, all see 'same day' patients in varying ways - and I think, without fail, no matter what the system patients complain about access. I have always thought that if you felt you needed an appointment that day and a nurse rang you back that to talk about it and find the most appropriate appointment slot for you was a good thing. But the practice that did that got as many complaints as places where you just pitched up in the morning and sat and waited and waited and waited.

How highly skilled is a GPs job? How highly skilled do you want your GP to be? Well. I see my job as trying to sort out who is sick and who isn't that sick.

So - when someone comes in to me with a headache I have to be able to tell whether that headache is just a headache, a migraine, a cluster headache, a brain haemorrhage, a brain tumour or they are just trying it on to get a day off work. I have to do this in approx 10mins otherwise the next patients on the list are waiting. Once I think I have decided what is going on with the headache I have to live with that.

Now - you could say that someone with no training could deal with this. Refer to neurologist. Easy. Of course, in the course of one surgery I could see 3-4 headaches. So I could just say "headache? yep - refer" (saves my time certainly so I can get back to counting my cash ) but then the neurologist has 4 more headaches to see - oh and the 4 that my colleague has seen. And the 4 that their colleague has seen. Oh - and another 4 that their colleague has seen. So then you have a neurologist seeing umpteen headaches when really all he/she wants to see is the ones that are worrying. The ones that are difficult. And all those headaches are filling up that clinic when the patients that really need that clinic are waiting and waiting.

There are crap GPs. There are excellent GPs. Most of us just try to do our best.

Oh and macdoodle - just realised that I know who you are!! Well - only from lurking about GP/couch areas (iyswim)! Didn't realise you were already on mat leave - seems to have come round quickly!

Oh - and it also doesn't work the same way as the 'free' market - restricting supply of trained doctors doesn't mean that the ones that are about can demand more pay. They still get the same pay scale.

What does interest me is how much people think doctors should be paid?

Compared to lawyers/solicitors etc etc who train for similar amounts of time we are paid very little. Indeed when I was the junior on nights I was the lowest paid in the hospital - we used to 'joke' that the cleaner that came round after we had brought someone round after a cardiac arrest was getting paid more than us.

The government has changed the contracts of both GPs and consultants so that they/we are paid for the work we do. The problem being that the government underestimated the amount of work we do. And the amount of work we did do over and above our 'hours' paid work. It seems as though no one actually looked into how much work doctors did before they agreed the new contracts.

Mcnoodle - The private doctor had the time to listen to us also he prescrived some sedatives for my father there and then which gave my father his first reasonable night's sleep in weeks.

When we reached a crisis with my father's sleeping we askd the GP if she could increas his sedative, she refused to prescribe any sedative over and above the very low dose he was already. She said my father had been referred to a geriatric psychiatrist and she would need to check with him what he could have.

This all sound fine except we had no idea he had been referred to a geriatric psychiatrist. We were not able to contact him and the GP had no number to give us so we were faced with 3 nights (Fri Sat and Sun) of my father having constant panic attacks and generally feeling very unwell and being completely unable to sleep.

We were informed that if we wanted extra sedatives we would need to take him to A&E if we thought it was an emergency.

He also arranged for an ultrsound scan of his stomach which is due to happen in a couple of days. Basically he took my father seriously and did not treat him like a nuisance.

I fully accept that the care my father receives on the NHS is very good quality, however the communication and co-ordination of services is absolutely terrible to put it mildly. It is in this gap that patients (and often their families) end up suffering greatly in an often needless way.

I have never said anything about how much GPs or any other docs are paid.

No Swedes, you have not mentioned pay.

But you did start out with, quite frankly, a rather rude and sweeping thread title/OP. and then you do the classic AIBU poster response of 'la la la fingers in my ears I can't hear you' when the overwhelming answer to your question is YABU.

And then you go on to make a further inflammatory comment about GPs working for the convinience of themselves rather than their patients, which was resulted in several posts that highlight that that is not the case.

And then you go on to say "I am finding all this patting one another on the back a bit weird".

Do you not understand how MN works? Did you not think that any GP mners, or those married to them, or others working in the NHS 'beast', or those mners who have a good relationship with their GP might not rally round.

There are always going to be absolutley valid AIBU threads where people have been shockingly treated by their GP.
No one is claiming here that GPs are any better than anyone else doing a hard days work.
No one is saying that there isn't room for improvement in the system, of course there is.

But your posts on this thread are, I'm afraid, highly unlikely to get you what you want, which is obviously a YANBU.

Clearly me asking AIBU means I had already contemplated the fact that I was being unreasonable. I was actually looking for reassurance that GPs do in fact do something with their 7 years' training other than delegate to the practise nurse and refer you to a hospital consultant, physio or whatever. And I agree the concensus of opinion is that they do. I am happy with that - even though that concensus opinion was formed overwhelmingly from GPs, GPs wives and employees within the NHS. Anyone with a dissenting opinion was summarily execututed. Laughable really.

Also I would like to know what is wrong with people diagnosing themselves? I believe there have been studies that prove patients are normally very accurate about pin pointing what is wrong with them. Personally, I think doctors should listen to their patients more.

I have noticed they're not as fast and loose with the drugs here as they are in the US, but I have ways of getting them to cough up the dope .

I don't work for the NHS

The people who work in the NHS know how it works. They also know how helpless the staff is at the minute. The politicians and managers make all the decisions about resources and how things work and yet have no clincical knowledge. They are not interested in good care for patients. They want to save money and give the appearance of good care...i.e. targets.

GP's, nurses, consultants have no control over anything but have to take the fall when stuff goes wrong.

It is unrealistic to always expect an immediate diagnosis and a clear cut plan. The hospitals are telling the GP's not to admit anyone for tests because they can't cope and that is probably a good thing for the elderly. They deteriorate fast in a hospital environment due to lack to staff and resources. It is actually worse for frail elderly people to be admitted much of the time.

You might want to check out this blogging GP.

www.drrant.net/2007/09/im-afraid-polly-filler-hasnt-clue.html

www.drrant.net/2007/04/myths-and-truths-about-your-gp.html

www.drrant.net/2007/08/bbc-have-your-say-fuckwit.html

www.drrant.net/2007/06/i-want-i-want-i-want-why-demands-for.html